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Background This systematic review aims to evaluate and compare differences in clinical outcomes for adult patients diagnosed with ISSPE who were managed with anticoagulation vs clinical surveillance.Methods PubMed, Embase, ProQuest, Cochrane, and Google Scholar were searched to identify studies evaluating the use of anticoagulation and/or clinical surveillance in patients diagnosed with ISSPE. The search included studies published up to August 3, 2023. Outcomes of interest included 90-day recurrent venous thromboembolism (VTE), major bleeding, and all-cause mortality rates.Results Ten studies were included with a total of 1224 patients. Of these patients, 791 were treated with anticoagulation and 433 underwent surveillance. Studies found no difference in recurrent VTE rates, with the majority of studies reporting no recurrence. Of the studies that reported VTE recurrence, rates were .5% to 1.4% for the anticoagulation groups and 3.1% to 3.2% for the surveillance groups. Major bleeding rates were also similar. In anticoagulated patients, major bleeding rates ranged from 1% to 10%. In clinical surveillance patients, the majority found no rate of major bleeding, with 2 studies reporting rates of .8% to 3.2%. Mortality rates ranged widely with no significant differences reported.Conclusion Clinical surveillance appears to be a safe and effective alternative to anticoagulation in patients with ISSPE. Ninety-day rates of recurrent VTE, major bleeding, and mortality were comparable between groups. These findings highlight the need for updated practice management guidelines to improve patient outcomes.

Educational institutions, which are crucial to a nation’s development, are also adopting e-governance principles and best practices. It is vital to find out the opinions of main personnel of higher educational institutions regarding the challenges they face in implementing e-governance for efficient university operations. Data was collected from 32 participants (teachers, registrars, librarians) from eight universities in Pakistan. Researchers used semi-structured interview protocols to collect data. We carried out thematic analysis for conclusions through interviews. It is explored that e-governance is being implemented in various universities’ operations. Students are provided facilities of e-governance in admissions, academic matters, examinations, and library. Teachers are provided facilities of e-governance in salary disbursements, attendance, communication, online classes, examinations and grading. Moreover, to implement e-governance the departments of universities face internet-based infrastructural, financial, technological, human, and developmental challenges. Findings of this study may well be used by universities’ stakeholders and administrators to understand well about the current status of e-governance in the universities. Moreover, they may well be able to better understand what advanced digital tools can be used to enhance the efficiency of e-governance systems. This study highlighted the status and challenges of e-governance in Higher Education on the stakeholders of Pakistani universities.

Background Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations’ caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients.Methods Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection.Results A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24 hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended.Conclusions Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24 hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.